Need advice! 6 day old baby losing weight - mw advice is to top up with formula, help am worried about my lo losing weight. Long post sorry!

[rosieposey]

I had my son last Friday and although i havent breastfed before or i have but its always gone a bit wrong ( he is my 4th ) i really wanted to try this time. I have a nice large age gap between him and my others (12 years) so am able to concentrate completely on him and hopefully get this breastfeeding thing nailed this time.

The midwife weighed him on day 4 in the evening and said that he had lost just over the 10 percent of weight that he was allowed and she said she' usually send him back to the hospital for tests but that she would come back and weigh him the next day but in in order for him to put weight on i would need to top up with formula.

I am an insulin dependent diabetic in pregnancy and it was touch and go whether he was going to end up in scbu anyway ( they were testing his bm's every three hours just before feeds ) and i was advised to formula feed him to get up his blood sugars initally as colostrum would have sent him crashing and straight to scbu ( doctors and mw's advice ) as it was the formula only just put him above the 2.6 that he was allowed to be but it was always my intention that when we got home i would feed him BM as soon as it came in.

He seems to latch on fine but falls asleep almost straight away with the effort of sucking so i started to express every feed for him so i could see what he was getting ( i was expressing up to 80 ml and he takes between 60 and 70 per feed ) so i thought he would put on weight fine and was shocked by the midwife telling me that he had lost just over the 10 percent. She told me to do formula top ups but tbh i just panicked and put him straight on formula in order to get him to gain weight and avoid going back to the hospital. I have been expressing every three hours still so that i can put him back on BM as soon as he gains enough weight but mentioned this on my ante natal thread and someone said i should post on here for advice. Am new to BFing and was expressing to make sure that he got BM that i thought he needed. I do still put him to the breast a couple of times a day for the two mins that he lasts before falling asleep because i dont want him to forget but as he was weighed yesterday and had put on the appropriate amount for one day it seems that the formula only route is working in terms of him putting on weight.

Sorry if this isinfo overload but thought id give the background to his feeding right from birth as is probably relevant. I would like to breastfeed exclusively but cant get him to stay awake for more than 3 mins so am having to express and i would like to know when i should stop ff and go back to bm even if it is expressed?

Oh should also mention that he has been quite jaundiced since day 2/3 and wonder if that has anything to do with losing weight on BM?

rosieposie - what a difficult time you are having

I think you need to talk about this in real life with someone who will explore beyond the option of formula. Numbers for helplines are here www.howbreastfeedingworks.com

You had a tricky start. I can't comment on the advice you got in those early days, but this is not what all mothers in your situation are told...hand expressing of colostrum is sometimes a viable option, for instance. But I do know that in some serious cases, this may not be enough

It sounds as if your baby has not had much practice at the breast because of being sleepy (jaundiced, too, which can affect alertness if it's more pronounced than normal neo-natal jaundice). He needs many, many more opprtunities to feed direct - twice a day will not work. It's really important to do skin to skin, co-bathing, co-sleeping, biological nurturing positions (google it) - never sleeping in a crib or a chair, but on you so you can respond quickly to feeding cues and so his instincts to feed and latch on are stimulated by your smell, taste and touch.

In the meantime, you need to express both breasts at least 8 x in 24 hours inc at least once at night, to preserve your milk supply and to get ebm which you can give your baby by bottle. The amount you get will determine how much formula he needs, and you can calculate, too, how much breastmilk he gets direct when he starts to breastfeed better (calculate will be a rough estimate, of course).

Hope this helps - what you are effectively needing now is to rescue your milk supply, and of course it can be done

I really don't know, but wanted to say good for you for trying, and for looking for answers. Keep asking and looking for alternatives until you find what works. I'm sure there is a way forward with the breastfeeding, if he is happily taking the breast, then he should be able to learn to suck more efficiently soon I reckon. Maybe he finds the bottles of EBM easier to suck, and so its making him tired at the breast, which is harder work? I see your predicement re the weight loss though

Actually, I don't know, I really just came to say BUMP, and I hope someone knowledgeable comes along soon

oh, brilliant, tiktok beat me to it

(she has good advice rosieposey - listen to her )

Thanks Tiktok and Astrophe - will look at that link and also increase the expressing from both breasts from 6 to 8 times a day. I do keep him in bed with me and you are right about the jaundice making him incredibly sleepy - i am hoping that it will go away within the next few days so that i can encourage him back on to the breast and hopefully make the effort to suck without falling asleep.

Good luck - its such hard work, but will be worth it.

I'm afraid I don't have any advice but just wanted to say I've just been through similar. I thought BF was going really well for first few days as DD was latching on and sucking and three different MWs said she was feeding fine. It was only when a different MW who was particularly good with BF advice came and watched her feeding that we found she was only doing weak sucks and just having a little drink and then falling asleep, rather than doing big sucks with her whole jaw to draw out all the milk. She lost 17% of her birthweight and we spent five days in hospital and I have now ended up formula feeding as I was constantly expressing and still couldn't produce enough and felt completely drained and just wanted her to get better.

Now looking back if there had been someone who could have sat with me and watched her feed a few times and given me support I might have persevered with BF. It seems you really have to push to get help as a lot of my MWs didn't seem to have a lot of time for it (well mine didn't!), so definitely keep ringing helplines and getting support, and on MN too!

DD was jaundiced too and I was advised to put her near natural daylight as much as possible, as well as keep feeding.

Hope it works out for you and he starts BF more soon.

My son and I were in a similar position. He was on the high risk protocol in the hospital because of medication I was on throughout my pregnancy. His blood sugar levels were monitored 3 hourly pre-feed and the 2.6 target became the bane of my life. It would be fine for almost a full 24 hours then drop again (and mean another day in hospital). The MW suggested cup-feeding formula but he threw it straight back up each time.

I believe this stress had a really bad effect on my milk in these early days. I also know that trying to force a bf baby to feed to a schedule is bad for getting milk supply established so trying to get him unfed for his three-hourly heel prick wasn't ideal. My son dropped from 9lb 6 to 8lb 8ozs in the first ten days and didn't seem to be in a hurry to grow. But I'm a stubborn so and so and I am determined to bf. Since getting out of hospital and going back to on-demand he has settled into a routine of his own and I expressed (a tiny amount!) after each feed to build up my supply. I just gradually used less formula and more boobs until I was back to exclusive bf. He's 12 weeks now and has dropped off a few centile lines but is happy and healthy and doing everything he should be (smiling, gurgling, peeing, pooing, etc).

If you are as determined as you sound, you'll do it this time! Good luck and let us know how you get on.

Good luck, sounds like relaxing, resting and a whole lot of skin to skin is needed.
I love these ladies with their super super advice, it is the most brilliant side of MN!!

PrettySprinkles thats exactly how i felt about the 2.6 target. He has gained three ozs in three days so i think thats about right or so they say and yesterday i put him back on expressed bm. I have been putting him to the breast alot but hes still sleepy from the jaundice and i find that i can get alot more into him when he is taking it from a bottle, not ideal i know but am hoping that when the jaundice wears off he will stick at bf'ing a little better as he does seem to know how to do it.

I have also been taking tiktoks advice and upping the amount i express too although i seem to be getting loads! or more than he would drink anyway - not sure what the protocol is there. Better too much than too little?

Oh yes!!!
Freeze it.Will come in useful!

Not an awful lot to add but wanted to say well done for persevering. The beginning can be very difficult for a straightforward breastfeeding relationship and you have additional complications too. You are doing very well indeed.

Just a thought but have you tried feeding him from a cup instead of a bottle? A bottle can be so easy for them that they do prefer it to bfing sometimes, which is hard work. I had a sleepy, jaundiced baby who couldn't latch on for the first couple of days and she fed from a cup until she had mastered latching.

keep at it rosie.
My DS is now 5 days and although I really just wanted him to have breast milk he was getting jaundiced and my milk hadn't come in so I let him have a few bottles as if his jaundice had got worse he would have been re-admitted. I've been BF as much as possible the last few days and topping up with bottles and thankfully at his hospital appt this morning he had put on weight and jaundice had not got worse.
I'm therefore going to try to just breastfeed now but with the occasional top up bottle which hopefully won't be needed much as my milk has finally come in.

Good luck Rosie

good luck Rosie - I've been thinking of you and lo.

Rosie, please check that your baby really did lose too much weight. I was told this with my baby and ordered to ff. It later became clear that they had made a mistake - so worth checking yourself.

Tiktok gives really brilliant advice on bf, please listen to her and call a bf counsellor that can see you in person to help. As far as I know breast milk help deal with jaundice better than ff, Tiktok pls confirm.

Expressing is an awful deppressing thing to do over the period of weeks and months, I hope you can manage to feed you baby directly very very regularly. This is something you have to dedicate all your time to I´m afraid, just for the immediate future.

sachertorte, correct, no reason to give formula instead of bf for jaundice...effective bf, done frequently enough, is totally appropriate 'treatment' for jaundice.

Ok got bubs weighed after the formula feeding and he put on the three oz's for the three days but have just had him weighed again today ( i have him solely on bm ) and he hasnt put on in the last three days at all Feel once again back to square one. Midwife says to put him on half bm and half formula to try and get him to gain weight have really been keeping my bm supply up and am expressing 120 ml which is over 4ozs every three to four hours so there is no problem with my supply at the moment at least. Just wish i could get lo to put some weight on solely on bm.

Am still latching him on and using the bottle to feed him expressed milk so that i could see that he was getting plenty and so that he didnt slide backwards but he appears to have anyway. Havent gotten around to calling a bf councillor as yet as was in Devon visiting my mum for the last three days - poor little Milo also has conjunctivitus and ive an infection in my c section wound so feeling a bit low all around really. Will keep on pumping every three hours though in the hope that i will eventually be able to solely bf.

Rosie - has he lost weight or just not gained any? 3 days is quite a short time between being weighed tbh. Have you spoken to a bfc in real life? They may be able to give you a second opinion and personally evaluate Milo to see if you could maybe continue with the ebf for a few more days. It's good that you are managing to express to keep your supply up - and you are getting quite a lot out so well done! I would def speak to a bfc in RL - you obviously want to move towards ebf and they will be able to help you with that. In my own opinion (just my own) I think it's a bit quick for the MW to be telling you to go back on formula after only 3 days if he hasn't actually lost weight but obviously you would be better off speaking to a bfc!

No he just hasnt gained any - the midwife said that he should be gaining 1 oz a day so to top up with formula - in her words she said that i could do 50/50 with formula and bm and that would hopefully get him to gain weight. She is coming back on Thursday to weigh him again and i hope to goodness he has gained something by then as it will be nearly a week and he will have been stuck at 8lb 2

rosie, from what you say here, I honestly don't understand the panic stations - 50/50 formula and breastmilk is a surefire way to ensure full formula feeding....I can't really comment on whether he 'ought' to have gained weight more by now (and there are issues with babies who've had a difficult start which make the usual suggestions not necessarily applicable) but if she really thinks he should be gaining as much as that, then of course giving him a lot of formula might well work - but at the expense of protecting your milk supply.

How about topping up with expressed breastmilk instead? Would the m/w be ok with that?

Was he weighed naked, on digital scales, with the weight translated accurately from metric, BTW?

Sorry, rosie I see he is already on expressed breastmilk, and I am assuming he is taking a good lot of the amount you are expressing?

In that case, he is bound to put on weight...giving formula instead is pointless as it won't give him any more calories.

How much, in terms of volume, does the m/w say he should have?

I am even more puzzled by the m/w's comments.

Well tiktok the midwife did comment on the fact that he was quite a 'snacky' baby and that the fact that he took between sixty and seventy mls per feed (every threeish hours) pointed to the fact that it wasnt conducive with him putting weight on. She said that bm was digested more quickly and i have no idea why formula is supposed to make babies put weight on more quickly. She said he needs to have around 100 - 120 mls every 4 hours and to make it so that the formula and bm ratio was 50/50 and that she would weigh him on Thursday to see if he had gained which she said he should if i was 'topping up' with formula.

It doesnt seem much like topping up to me though tbh more like 'replacing'?

Sorry and yes he was weighed naked on digital scales - he hadnt put on an oz since Friday

snacky baby? Hate that silly phrase. Nonsense.

Tiny tum, frequent feeds. And I completely fail to see how being snacky would prevent weight gain, as long as baby takes the right amount of milk over 24hours.

100mil every 4 hours is 600mils
60 mils every 3 hours is 480mils

but it all depends on how much this baby actually needs.

your mw seems to think that baby gets fewer calories from bm because it is moreeasily digested .

Still puzzled!!

You are getting 120 mls every three hours expressing, yes?

You give it to him by bottle. He takes 60-70 mls every 3 hours. So 520 mls in 24 hours.

She wants him to have 100-120 mls every four hours, which would be about 660 mls in 24 hours - so his intake is 140 mls shy of the desired total. You have this volume in ebm, don't you? So he could have it, in between the 60-70 mls he already takes.

Why would this not be acceptable?

Well done for persevering Rosie - and expressing seems to be going really well too - fantastic.

Just a bit of reassurance really as Tiktok is such an expert. My ds was 10lbs 5oz when he was born. He dropped to 9lbs 3oz in his first week - I was exclusively bf. No one raised an eyebrow. He then started to gain weight - but not at a great rate - he dropped from the 95% to the 75% where he stayed quite happily. I suppose this is just to say that not all babies put on weight at the same rate...

Good luck